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Original Articles

Esophageal Capsule Endoscopy After Radiofrequency Catheter Ablation for Atrial Fibrillation

Documented Higher Risk of Luminal Esophageal Damage With General Anesthesia as Compared With Conscious Sedation

Luigi Di Biase, MD; Luis Carlos Saenz, MD; David J. Burkhardt, MD; Miguel Vacca, MD; Claude S. Elayi, MD; Conor D. Barrett, MD; Rodney Horton, MD; Rong Bai, MD; Alan Siu, MD; Tamer S. Fahmy, MD; Dimpi Patel, DO; Luciana Armaganijan, MD; Chia Tung Wu, MD; Sonne Kai, MD; Ching Keong Ching, MD; Karen Phillips, MD; Robert A. Schweikert, MD; Jennifer E. Cummings, MD; Mauricio Arruda, MD; Walid I. Saliba, MD; Milan Dodig, MD and Andrea Natale, MD

From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.J.B., R.H., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Cleveland Clinic (L.D.B., C.S.E., C.D.B., R.B., A.S., T.S.F., D.P., L.A., C.T.W., S.K., C.K.C., K.P., R.A.S., J.E.C., M.A., W.I.S., M.D.), Cleveland, Ohio; Stanford University (A.N.), Palo Alto, Calif; and the Fundation Cardio Infantil (L.C.S., M.V.), Bogota, Colombia.

Correspondence to Andrea Natale, MD, St David’s Medical Center, 1015 East 32nd Street, Austin, TX 78705. E-mail dr.natale{at}gmail.com

Received August 15, 2008; accepted February 11, 2009.

Background— Left atrioesophageal fistula is a rare but devastating complication that may occur after catheter ablation of atrial fibrillation. We used capsule endoscopy to assess esophageal injury after catheter ablation for atrial fibrillation in a population randomized to undergo general anesthesia or conscious sedation.

Methods and Results— Fifty patients undergoing atrial fibrillation ablation for paroxysmal symptomatic atrial fibrillation refractory to antiarrhythmic drugs were enrolled and randomized, including those undergoing the procedure under general anesthesia (25 patients, group 1) and those receiving conscious sedation with fentanyl or midazolam (25 patients, group 2). All patients underwent esophageal temperature monitoring during the procedure. The day after ablation, all patients had capsule endoscopy to assess the presence of endoluminal tissue damage of the esophagus. We observed esophageal tissue damage in 12 (48%) patients of group 1 and 1 esophageal tissue damage in a single patient (4%) of group 2 (P<0.001). The maximal esophageal temperature was significantly higher in patients undergoing general anesthesia (group 1) versus patients undergoing conscious sedation (group 2) (40.6±1°C versus 39.6±0.8°C; P< 0.003). The time to peak temperature was 9±7 seconds in group 1 and 21±9 seconds in group 2, and this difference was statistically significant (P<0.001). No complication occurred during or after the administration of the pill cam or during the procedures. All esophageal lesions normalized at the 2-month repeat endoscopic examination.

Conclusion— The use of general anesthesia increases the risk of esophageal damage detected by capsule endoscopy.

Key Words: catheter ablation of atrial fibrillation • complications • esophageal injury • left atrioesophageal fistula • left atrium

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CLINICAL PERSPECTIVE

Related Article

Esophageal Capsule Endoscopy After Radiofrequency Catheter Ablation for Atrial Fibrillation: Documented Higher Risk of Luminal Esophageal Damage With General Anesthesia as Compared With Conscious Sedation

Luigi Di Biase, Luis Carlos Saenz, David J. Burkhardt, Miguel Vacca, Claude S. Elayi, Conor D. Barrett, Rodney Horton, Rong Bai, Alan Siu, Tamer S. Fahmy, Dimpi Patel, Luciana Armaganijan, Chia Tung Wu, Sonne Kai, Ching Keong Ching, Karen Phillips, Robert A. Schweikert, Jennifer E. Cummings, Mauricio Arruda, Walid I. Saliba, Milan Dodig, and Andrea Natale
Circ Arrhythm Electrophysiol 2009 2: 108-112. [Abstract] [Full Text] [PDF]